Deck 10: Communication and the Clinical Interview

Question 1

During the first interview with a parent whose child died in a car accident, the nurse feels empathic and reaches out to take the patient's hand. Select the correct analysis of the nurse's behaviour.

A) It shows empathy and compassion. It will encourage the patient to continue to express feelings.
B) The gesture is premature. The patient's cultural and individual interpretation of touch is unknown.
C) The patient will perceive the gesture as intrusive and overstepping boundaries.
D) The action is inappropriate. Psychiatric patients should not be touched.

Answer 1

The gesture is premature. The patient's cultural and individual interpretation of touch is unknown.

Question 2

When a female Indigenous patient and a female nurse sit together, the patient often holds the nurse's hand. The patient also links arms with the nurse when they walk. The nurse is uncomfortable with this behaviour. Which analysis is most accurate?

A) The patient is accustomed to touch during conversation, as are members of many Indigenous cultures.
B) The patient understands that touch makes the nurse uncomfortable and controls the relationship based on that factor.
C) The patient is afraid of being alone. When touching the nurse, the patient is reassured and comforted.
D) The patient is trying to manipulate the nurse using nonverbal techniques.

Answer 2

The patient is accustomed to touch during conversation, as are members of many Indigenous cultures.

Question 3

A school-age child tells the school nurse, "Other kids call me mean names and will not sit with me at lunch. Nobody likes me." Select the nurse's most therapeutic response.

A) "Just ignore them and they will leave you alone."
B) "You should make friends with other children."
C) "Call them names if they do that to you."
D) "Tell me more about how you feel."

Answer 3

"Tell me more about how you feel."

Question 4

An Indigenous patient had a nursing diagnosis of situational low self-esteem related to poor social skills as evidenced by lack of eye contact. Interventions were used to raise the patient's self-esteem, but after 3 weeks, the patient's eye contact did not improve. What is the most accurate analysis of this scenario?

A) The patient's eye contact should have been directly addressed by role-playing to increase comfort with eye contact.
B) The nurse should not have independently embarked on assessment, diagnosis, and planning for this patient.
C) The patient's poor eye contact is indicative of anger and hostility that were unaddressed.
D) The nurse should have assessed the patient's culture before making this diagnosis and plan.

Question 5

Documentation in a patient's chart shows, "Throughout a 5-minute interaction, patient fidgeted and tapped left foot, periodically covered face with hands, and looked under chair while stating, 'I enjoy spending time with you.'" Which analysis is most accurate?

A) The patient is giving positive feedback about the nurse's communication techniques.
B) The nurse is viewing the patient's behaviour through a cultural filter.
C) The patient's verbal and nonverbal messages are incongruent.
D) The patient is demonstrating psychotic behaviours.

Question 6

A patient is having difficulty making a decision. The nurse has mixed feelings about whether to provide advice. Which principle usually applies?

A) Giving advice is rarely helpful.
B) Giving advice fosters independence.
C) Giving advice lifts the burden of personal decision making.
D) Giving advice helps the patient develop feelings of personal adequacy.

Question 7

A black patient says to a white nurse, "There's no sense talking. You wouldn't understand because you live in a white world." Which of the following would be the nurse's best action?

A) Explain, "Yes, I do understand. Everyone goes through the same experiences."
B) Say, "Please give an example of something you think I wouldn't understand."
C) Reassure the patient that nurses interact with people from all cultures.
D) Change the subject to one that is less emotionally disturbing.

Question 8

Which principle should guide the nurse in determining the extent of silence to use during patient interview sessions?

A) A nurse is responsible for breaking silences.
B) Patients withdraw if silences are prolonged.
C) Silence can provide meaningful moments for reflection.
D) Silence helps patients know that what they said was understood.

Question 9

While talking with a patient diagnosed with major depression, a nurse notices the patient is unable to maintain eye contact. The patient's chin lowers to the chest, while the patient looks at the floor. Which aspect of communication has the nurse assessed?

A) Nonverbal communication
B) A message filter
C) A cultural barrier
D) Social skills

Question 10

During an interview, a patient attempts to shift the focus from self to the student nurse by asking personal questions. The student nurse should respond by saying:

A) "Why do you keep asking about me?"
B) "Nurses direct the interviews with patients."
C) "Do not ask questions about my personal life."
D) "The time we spend together is to discuss your concerns."

Question 11

A patient discloses several concerns and associated feelings. If the nurse wants to seek clarification, which comment would be appropriate?

A) "What are the common elements here?"
B) "Tell me again about your experiences."
C) "Am I correct in understanding that . . ."
D) "Tell me everything from the beginning."

Question 12

The patient says, "My marriage is just great. My spouse and I always agree." The nurse observes the patient's foot moving continuously as the patient twirls a shirt button. The conclusion the nurse can draw is that the patient's communication is which of the following?

A) Clear
B) Mixed
C) Precise
D) Inadequate

Question 13

A patient diagnosed with schizophrenia tells the nurse, "The CIA is monitoring us through the fluorescent lights in this room. Be careful what you say." Which response by the nurse would be most therapeutic?

A) "Let's talk about something other than the CIA."
B) "It sounds like you're concerned about your privacy."
C) "The CIA is prohibited from operating in health care facilities."
D) "You have lost touch with reality, which is a symptom of your illness."

Question 14

A patient with acute depression states, "God is punishing me for my past sins." What is the nurse's most therapeutic response?

A) "You sound very upset about this."
B) "God always forgives us for our sins."
C) "Why do you think you are being punished?"
D) "If you feel this way, you should talk to your minister."

Question 15

During a one-on-one interaction with the nurse, a patient frequently looks nervously at the door. Select the best comment by the nurse regarding this nonverbal communication.

A) "I notice you keep looking toward the door."
B) "This is our time together. No one is going to interrupt us."
C) "It looks as if you are eager to end our discussion for today."
D) "If you are uncomfortable in this room, we can move someplace else."

Question 16

An Italian Canadian patient uses dramatic body language when describing emotional discomfort. Which analysis most likely explains the patient's behaviour?

A) The patient has a histrionic personality disorder.
B) The patient believes dramatic body language is sexually appealing.
C) The patient wishes to impress staff with the degree of emotional pain.
D) The patient belongs to a culture in which dramatic body language is the norm.

Question 17

Which technique will best communicate to a patient that the nurse is interested in listening?

A) Restating a feeling or thought the patient has expressed
B) Asking a direct question, such as "Did you feel angry?"
C) Making a judgement about the patient's problem
D) Saying, "I understand what you're saying."

Question 18

A patient says to the nurse, "I dreamed I was stoned. When I woke up, I felt emotionally drained, as though I hadn't rested well." Which response should the nurse use to clarify the patient's comment?

A) "It sounds as though you were uncomfortable with the content of your dream."
B) "I understand what you're saying. Bad dreams leave me feeling tired, too."
C) "So you feel as though you did not get enough quality sleep last night?"
D) "Can you give me an example of what you mean by 'stoned'?"

Question 19

A patient tells the nurse, "I don't think I'll ever get out of here." Select the nurse's most therapeutic response.

A) "Don't talk that way. Of course you will leave here!"
B) "Keep up the good work, and you certainly will."
C) "You don't think you're making progress?"
D) "Everyone feels that way sometimes."

Question 20

A nurse interacts with a newly hospitalized patient. Select the nurse's comment that applies the communication technique of "offering self."

A) "I've also had traumatic life experiences. Maybe it would help if I told you about them."
B) "Why do you think you had so much difficulty adjusting to this change in your life?"
C) "I hope you will feel better after getting accustomed to how this unit operates."
D) "I'd like to sit with you for a while to help you get comfortable talking to me."

Question 21

A nurse is interacting with patients in a psychiatric unit. Which statements reflect use of therapeutic communication?

A) "Tell me more about that situation."
B) "Let's talk about something else."
C) "I notice you are pacing a lot."
D) "I'll stay with you a while."
E) "Why did you do that?"

Question 22

Which comments by a nurse demonstrate use of therapeutic communication techniques?

A) "Why do you think these events have happened to you?"
B) "There are people with problems much worse than yours."
C) "I'm glad you were able to tell me how you felt about your loss."
D) "I noticed your hands trembling when you told me about your accident."
E) "You look very nice today. I'm proud you took more time with your appearance."

Question 23

During the initial patient interview, which of the following are reasons that the patient may be reluctant to speak?

A) Feelings of distrust
B) The nurse is a health care provider
C) Feelings of embarrassment
D) Repetitive nature of the situation
E) Shyness

Question 24

A patient cries as the nurse explores the patient's feelings about the death of a close friend. The patient sobs, "I shouldn't be crying like this. It happened a long time ago." Which responses by the nurse facilitate communication?

A) "Why do you think you are so upset?"
B) "I can see that you feel sad about this situation."
C) "The loss of a close friend is very painful for you."
D) "Crying is a way of expressing the hurt you are experiencing."
E) "Let's talk about something else because this subject is upsetting you."